Massachusetts Small Business Health Insurance
Due to state insurance regulations and higher than average
group health insurance costs resulting, it is in the Massachusetts small
business owner's best interest to personally explore all their health insurance
options through an independent broker that specializes in the health insurance
area. This way the business owner has a better chance of finding out about all
their options and those that are the most cost effective for his business.
The plans with the least bells and whistles and
the least restrictions and best access to providers at a fair price will always
provide the best coverage for your money.
For small groups of generally between 2 and 50 employees, here's
an example of what to look for in a quality group health plan typically found only in PPO
plans in Massachusetts...
- Low co-pays for office visits, Prescriptions, Emergency Room,
Urgent Care co-pays (or even better -- 100% coverage after your out of
pocket maximum is reached)
- NO PRIMARY CARE PHYSICIAN REQUIREMENTS
NO Blacklisted Prescriptions Drugs
- Nationwide access to nearly 4000 hospitals and almost 400,000
doctors -all considered "in-network" allowing you to
"keep your doctors"
- Coverage outside the network for an additional out-of-pocket cost
- $5 million lifetime maximum both inside and outside the network
The "bottom line" is it is possible to get a lot more
important benefits for a lot less
cost with a PPO plan with a quality national network of providers, such as
Private Healthcare Systems www.phcs.com,
if you know how to shop. The trick is knowing where to look for carriers with
sensible plan designs and reasonable premiums. Second only to pure indemnity
plans, PPO plans however, typically are the MOST EXPENSIVE types of health
insurance due to the fact that the insured person has the MOST CONTROL
over his care and the MOST FREEDOM to go anywhere he chooses for care.
Too many groups rule out PPO plans too soon because they think
they'll be too expensive. In some cases with some carriers, they may be right
BUT IMPLEMENTING AN HRA (Health Reimbursement Arrangement) along with a PPO
makes obtaining one a lot more feasible as you'll see in the example
We found the following PPO options with Blue Cross Blue Shield of
Massachusetts; Aetna, Guardian and John Alden for a company in Boston with 6
employees (4 families and 2 individuals) . The average employee age was 40.
|| D w/ HRA
|Office Visit Co-pay
|Hospital Admission Co-pays
|Coinsurance % In-network
|Out of Pocket Max. In-network
0 N/A after HRA reimbursement
|Total In-network Deductibles&
||$500/$1500 after HRA reimbursement
|Group Monthly Premiums
Since the carrier that offered plan "A" had a
51% of a groups employees work in Massachusetts, we had to rule that one out as
half of the employees of this company worked out of state. The carrier
offering Plan "B" obviously wasn't even in the ball park as far as
protection was concerned. We didn't even
bother to check the rates. We thought the price would have had to have been
practically FREE to even consider that plan.
Carriers offering plans outlined in columns "C" and
"D" were left.
Which one seems to provide the best value for the money?
With nearly $20,000 savings provided in plan
"D", we suggested that implementing a custom Health Reimbursement
Arrangement (HRA) to reimburse employees for the extra $2500 out of pocket
maximum using the premium savings that Plan "D" provided would give
the employees the same 100% benefit after the $500 deductible as in plan
"C" without having to pay the higher premium for the benefit
made the most sense since the the company's total risk was only $25,000, and
that was ONLY if 100% of all of their employees and their dependents all were
hospitalized with a major illness or injury the same year, (which would
likely put the company out of business and would likely never happen). 80%
of the company's employees and their dependents would need to be hospitalized
and require full reimbursements just to equal the cost of plan "C"
which would also, it is safe to say, probably never happen.
What was more likely to happen in a BAD year was that perhaps 30% of them
might need their full reimbursement. So we figured 30% of the entire risk was
only $7500 which would leave the company with over $12,000 cash savings - In a
BAD YEAR, no less!
Wondering which carrier offered which plan? Call us to find
"How much can you save?" This depends on a number of factors
but our average prospective client currently insured with a
popular HMO or POS plan saves between $1000 to $3000 per covered employee per
"Why hasn't my broker shown me this before?" you may be
wondering. There are a few reasons but the primary answer is. simply due to the
fact that not every independent broker is authorized to offer it .
By using a broker who only offers the advertised plans you've been missing
out on big opportunities to save on group health insurance premiums.
You've also been settling for plans with more restrictions and smaller
networks. Isn't it time you got a better health insurance value through
Health Plan Specialists? See if your company qualifies. All
it takes is 6 simple steps....